California Department of Education

Child Development Division

March 2013

CD 4000
Page 1

Instructions for
Program Self-Evaluation Annual Report (CD 4000)
Prepare one Program Self-Evaluation Annual Report (CD 4000) form for each applicable
packet for center-based contract type by age group, education network by age group, and/or
Cal-SAFE program.
Contract Types:
CSPP: California State Preschool Program
CCTR: California Center-based
CHAN: California Severely Handicapped
CFCC: California Family Child Care Home Education Network
CMIG: California Migrant
Cal-SAFE: California School-Age Families Educationa program providing child care services
for children of students, through state funding sources other than the contracts
listed above.
Instructions for CD 4000

Insert the Contractors legal name.

Insert the Vendor Number for center-based contract. For Cal-SAFE programs, check the
box and enter the CDS Code.

Check the contract type by age group, education network by age group, or Cal-SAFE.

Insert the date the PSE Annual Report was completed.

Insert the number of classrooms for the identified contract type, as applicable.

Insert the number of family child care homes, as applicable.

Describe the PSE Process

Use this space to write an overview of the self-assessment process used by

the contractor to evaluate its program quality, including activities for all contract
types. Describe the role of parents, staff, and board members in the PSE
process, and how they were involved with the DRDP, ERS, and Parent Survey
Summary of Findings. Include the start and completion date. Note: This
information should be comprehensive and include a reference to all
applicable contract types. This section may then be duplicated for each
packet submission.

California Department of Education

Child Development Division
March 2013

CD 4000
Page 2

Insert the date(s) the PSE will be or has been presented to the governing board,
parents, and teaching/program staff. This may be a range of dates if more than one
meeting will be held, i.e. four meetings July thorough August 2012.

Complete the Statement of Completion with a signature, date, and phone number.

California Department of Education

March 2013

California Department of Education

Child Development Division

CD 4000
March 2013

Program Self-Evaluation Annual Report

Contractors Legal Name
Los Angeles Unified School District/Gratts Early Education Center
Vendor Number
Cal-SAFE
CDS Code
Contract and
CSPP
Age
CCTR (Infant/Toddler)
CCTR (School-Age)
Education Network (Infant/Toddler)
Education Network (Preschool)
CHAN
CMIG - (Infant/Toddler)
CMIG - (Preschool)
Date Program Self-Evaluation Completed
April 2014
Number of Classrooms
6
Number of Family Child Care Homes
Describe the Program Self-Evaluation Process (Note: This area expands as necessary.)
Program Action Plan:
The program action plan was developed using the Summary of Findings from each of the
following instruments: Parent Survey; Desire Results Developmental Profile-Revised (2010) and
Early Childhood Environmental Rating Scale. Staff identified a trend between the three
instruments and established a goal and objectives.
Early Childhood Environmental Rating Scales (ECERS-R):
An ECERS-R was completed for 6 classrooms, two items scored at a rating of 5 or less for the
classroom. The items and the actions steps taken are identified on the attachment.

A copy of the Program Self-Evaluation will be/has been presented

to the Governing Board.
A copy of the Program Self-Evaluation will be/has been presented
to teaching/program staff.
A copy of the Program Self-Evaluation will be/has been presented
to parents.
Statement of Completion
Signature
I certify that a Program
Self-Evaluation was completed. Name, Title, and Phone Number
Ana Oregel,
Principal
(213) 681-3230

Date
Date July 2014
Date September 2014
Date
April

, 2014